By Sola Ogundipe
ALTHOUGH Nigeria currently has about 3 million people living with HIV and ranks second only to South Africa in terms of disease burden globally, one of the key priorities by the Federal government to fast-track progress towards ending AIDS by 2030, is to build on the successes that treatment has had on prevention and control in the last 15 years.
Disclosing this in Abuja during the just concluded National HIV Prevention Conference 2016, Director General of the National Agency for the Control of AIDS, NACA, Dr. Sani Aliyu, said prevention is key to HIV control and remains an essential part of any programme.
Aliyu, who spoke at the conference themed “Hands-on for HIV Prevention”, observed that the impact prevention has had on the HIV epidemic has been significant was a reflection of sustained commitment
“Here in Nigeria, we have recorded a steady decline in HIV prevalence from a peak of 5.8 per cent in 2001 to 3.0 per cent in 2014. In the last five years, we have reduced new HIV infections by 20 per cent and AIDS related death by 15 per cent.
“From the perspective of preventing new HIV infections, as a country, we are only 10 per cent away from reaching the magic tipping point. However, the speed at which we are reducing new HIV infections needs to accelerate if we must meet our fast-track targets by 2020.”
He said the increased knowledge of the common prevention approaches including being faithful and barrier protection no doubt has contributed to the downward trajectory of HIV/AIDS.
Challenges: “But this has not been an easy ride and challenges still exist – condom use is still too low and covers less than half of our need in sub-Saharan Africa. There is a dearth of knowledge on HIV among young people with only a third having enough HIV knowledge to safeguard themselves.”
He said the conference came at a most appropriate time when Nigeria was revising its national HIV/AIDS strategic framework to guide response over the next five years.
“It presents opportunity to chart the future of our national HIV prevention programme, such that the achievement of 2020 fast-track targets is guaranteed.”
Renewed commitment: Giving assurance of NACA’s renewed commitment to a much stronger, robust, inclusive and accountable national response, the DG notedthat: “Following the 2011 landmark HPTN052 Study, we now have very good evidence that ART is effective in cutting transmission by up to 96 per cent.
“In addition to this, pregnant women who take antiretroviral treatment and adhere to treatment up to the postpartum period are able to reduce the risk of transmission from as high as 30 per cent to less than 1 per cent. Similar impact on transmission rates has been reported for sero-discordant partners. This is a real achievement for the scientific community and makes the goal of eradicating HIV a possibility.”
Aliyu said the goals for HIV prevention are shifting – from just thinking about barrier precautions to the common goal of achieving an undetectable viral load and hence eliminating transmission.
“This means that the arbitrary distinction between HIV prevention and treatment has become blurred. In order to achieve the 2030 goal of HIV eradication, we must approach prevention as a continuum and adopt a ‘combination’ approach similar to what applies with ART,” he noted.
In his view: “Treatment as prevention, whether pre- or post- exposure or established ART is becoming the norm. But this is not without cost – treatment is considerably more expensive than primary prevention. “Treatment can only be affordable through an effective prevention programme that stabilises the pool of infection by reducing the number of new HIV infections to a sustainable level to allow for country ownership of the response.
“The new approach to prevention is unique but challenging – tremendous progress has been made in the science of prevention.
“Nevertheless it is important that while we move on to the ‘combination approach,’ we also make the best use of implementation science approaches to determine whether current evidence on the effectiveness of the different approaches can be applicable to our local context.
“We also need to think about adherence, which is critical to any successful attempt to incorporate antiretrovirals as core prevention.”